Little League Elbow Syndrome Follow-up

Updated: Aug 30, 2018
  • Author: Holly J Benjamin, MD, FAAP, FACSM; Chief Editor: Craig C Young, MD  more...
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Follow-up

Return to Play

Return to throwing activities in individuals with little league elbow syndrome should be carefully monitored by the patient and his or her family in conjunction with an educated trainer, the coach, and a pediatric sports medicine or orthopedic specialist. The return to competitive pitching should begin when an athlete has fully completed his or her rehabilitation program. As the athlete returns to competition, careful attention to pitch types, pitch counts, a proper rotation schedule, and maintenance of core strength and flexibility is necessary. [25]

Table. (Open Table in a new window)

Maximum Pitch Counts — Game Competition

(Adapted From USA Baseball Recommendations)  [11]

Age, y

Pitch Approved to Throw

Pitches per Game

Pitches per Week

Pitches per Season

Pitches per Year

9–10

Fastball

50

75

1000

2000

11-12

Change-up

75

100

1000

3000

13-14

Curveball

75

125

1000

3000

15-16

Slider, forkball, splitter, knuckleball

90

-

-

 

17-18

Screwball

105

-

-

 

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Complications

Even with a reasonable long-term maintenance program, complications such as posttraumatic arthritis, permanent flexion contractures, and growth or angular deformities may occur following little league elbow syndrome.

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Prevention

Prevention can be accomplished by educating parents, players, and coaches about the symptoms and sequelae of little league elbow syndrome. Emphasis should be placed on proper throwing techniques during practices and games. Pitch counts, pitch types, and a proper rotation schedule should be followed. The number of competitive pitches thrown in practice and the number of innings per week, per season, and per year should be monitored. The results of a 10-year cohort study found that young baseball pitchers who pitch more than 100 innings a year are at significantly increased risk of elbow or shoulder injury. [26] The prescreening physical examination affords an excellent opportunity for the physician to provide this information.

Proper warm-up time and proper strength and flexibility exercises should be maintained during the off-season or initiated at least 6 weeks before the first practice. Pitching should be limited to 9 months per year maximum, and an off-season interval throwing program is important. Proper biomechanics should be emphasized at all times. Athletes should be encouraged to seek medical care when symptoms of throwing-related elbow pain develop.

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Prognosis

Prognosis for recovery from little league elbow syndrome is guarded and depends on the specific pathologic process. In general, disorders that affect the articular surfaces of the elbow, such as the capitellum and radial head, as well as those that affect the normal growth and development of the elbow have the worst long-term prognosis. Over the short term, most cases of little league elbow syndrome resolve with rest and conservative management. Osteoarthritis is a potential long-term complication. Functional disability and permanent deformity can result from proper or improper management.

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Education

Little league elbow syndrome, as well as other sports-related injuries, can be discussed with parents and players during the preparticipation physical examination. This is an excellent opportunity for physicians to educate their patients about causes, symptoms, and prevention of sports injuries. [25]

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